Pathology
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Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
Index
Contents
Authors
ExpSys: non-tumors
ExpSys: tumors
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+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Melanoma metastases
Histology

Nodule of melanocytes, often multiple, located intradermally, usually roundish. Usually at least some epidermotropism is present (epidermotropic metastases). Mitotic activity and cellular atypia are usually prominent. Melanin production is variable.

Melanoma metastasis (10228)

Melanoma metastasis (10228)

Pictures

Melanoma, metastasis: Metastasis of a melanoma, HE 40x (2299)

Another case: Metastasis of a melanoma, HE 20x (2415)

Another case: Metastasis of a melanoma, HE 40x (2711)

Another case, ear: Metastasis of a melanoma, external ear, HE 20x (2715) Metastasis of a melanoma, HE 40x (2716)

Metastasis of epiteloid melanoma, high mitotic activity: Metastasis of a melanoma, HE 40x (3498)

Tiny metastasis of melanoma: Small metastasis of a melanoma, HE 40x (5501)

Melanoma metastasis: Metastasis of a melanoma, HE 60x (6259)

Melanoma metastasis: Metastasis of a melanoma, HE 40x (10830) Metastasis of a melanoma, HE 40x (10228)

Melanoma metastasis: Metastasis of a melanoma, HE 20x (13204)

Nodular melanoma, satelites: Nodular melanoma, satelite, HE 20x (14607) Nodular melanoma, satelite, HE 20x (14608)

Case study
Metastatic amelanotic malignant melanoma
MUDr. Hana Jedličková, PhD.
Introduction

Amelanotic melanoma is a rare variant of malignant melanoma. Due to its lack of the pigment, the clinical diagnosis is often difficult. Melanin synthesis is disturbed in increased hypoxia and acidity of malignant cells. Tyrosinase, which is essential for melanin synthesis, is accumulated and degraded within the endoplasmic reticulum. Not only late clinical recognition but also biochemical properties of amelanotic melanoma enhance the metastatic spread of this variant. Amelanotic metastases are not uncommon also in cases of primary pigmented melanomas.

History

70 year old man noticed eruptive pink papules on his right shin in a vicinity of a scar after the taking of a vein graft. The clinical diagnosis was eruptive xanthoma; the papules were examined histologically with the result of a melanocytic nevus.

The patient had a history of hypertension and chronic heart disease; he had had a coronary artery bypass surgery two years earlier. For some time he had a chronic defect on his right sole which was considered as an ischemic ulceration by his physician.

As the histological results did not correlate with the clinical picture, the patient was examined by a dermatologist and clinical diagnosis of an amelanotic metastatic melanoma of the sole was made, This diagnosis was confirmed by histopathology.

Clinical signs

Several pink tough papules, 3 – 5mm in diameter, on the anterior aspect of the right shin. An ulcer 2 cm in diameter with irregular borders and small amount of light brown pigment in the adjacent skin was found on the right sole.

Melanoma (4071)

Metastases (4070)

Histology

A symmetric dome shaped papule. The epidermis with a collarette and no epidermotropism. Dermis is filled with an infiltrate of melanocytes with nuclear atypias and prominent nucleoli; atypical mitoses can be found. Superficially the cells are organized in nests, the lower margin is sharply demarcated, and the pigment is sparse. The cells are Ki 67 and Melan A positive.

Metastasis (3529)

Pictures

Primary melanoma of the sole: Metastazing melanoma of the sole, Clinical picture (4071)

Metastases of the melanoma on the sole, note the scar where the venous graft for the bypass was taken: Melanoma metastases (scar after venous graft removal), Clinical picture (4070)

Metastases of a melanoma, with maturation, minimal epidermotropism, minimal mitotic activity, symmetry, flat bottom: Metastasis of a melanoma, HE 40x (3529) Metastasis of a melanoma, HE 40x (3530) Metastasis of a melanoma, Melan A 20x (3573) Metastasis of a melanoma, Ki67 40x (3574)

Melanoma metastasis: Metastasis of a melanoma, HE 40x (10949) Metastasis of a melanoma, HE 40x (10950)

Melanoma metastasis: Metastasis of a melanoma, HE 20x (5466) Metastasis of a melanoma, HE 20x (4815)

Recurrent melanoma: recurrence over the scar after previous excision and metastasis in vicinity: Recurrent melanoma, HE 20x (14624) Recurrent melanoma, HE 20x (14625)